General Population Risk Individuals (Green)
Some factors may be amenable to change and your patient should be encouraged to minimise their risk by adopting a healthy lifestyle, including avoiding obesity, taking regular exercise, avoiding excess alcohol and eating a healthy diet.
Make the patient aware that their risk may change, should a relative be diagnosed with bowel cancer or a related cancer (endometrial, gastric, ovarian, pancreatic and urothelial) in the future. If this is the case, you would like to see them again for reassessment.
Moderate and High Risk Individuals (Amber)
Discuss with your patient that their risk of developing a familial cancer may be raised and this needs further assessment.
At this stage it may not be possible to know whether your patient is at moderate, high or very high risk but there may be some pointers in the history.
The level of detail with which an individual clinician may want to discuss these areas with a patient will depend on the clinician’s knowledge. You may want to discuss some of the following issues.
- Patients with many affected family members with the same or related cancers which develop at a young age are more likely to have one of the dominantly inherited faulty bowel cancer genes (HNPCC or FAP). These patients will be in the high risk category for developing bowel cancer (>10% lifetime risk) but having a faulty gene does not automatically mean that the individual will develop bowel cancer.
- The majority of patients at raised risk of developing bowel cancer will be in the moderately raised risk category (approx 10% lifetime risk). These patients are unlikely to have inherited a faulty dominant bowel cancer gene and much more likely to have inherited some polygenic increased susceptibility combined with environmental and lifestyle factors.
